Cancer of the neovagina.
OBJECTIVE
Cancer of the neovagina has been documented, and found to occur at younger ages than cancer of the native vagina. A review of the world literature was performed to evaluate risk based on type of tissue used for replacement or reconstruction of the vagina, as well as signs and symptoms of tumor occurrence and follow-up possibilities for early detection/screening for cancer and precancerous changes.


METHODS
Comprehensive review of relevant published literature.


RESULTS
Creation of a neovagina is infrequently performed with no established follow-up pattern. Neovaginal construction uses a variety of tissues: bowel, skin graft, vulvar skin flaps, rectus abdominus (myocutaneous) flaps, inverted penile skin. When exogenous tissue is used, tissue dysplasia can be expected because the tissue is suddenly subjected to new contacts/stresses. Pathological criteria of abnormality in epithelium transplanted to a vaginal location are not well established. Case reports suggest that squamous cell cancers occur in skin-graft vaginal constructions and adenocarcinomas occur in vaginas constructed of bowel. Clear or bloody discharge and postcoital bleeding are the most frequent first symptoms. Endoscopy and biopsy are needed for diagnosis.


CONCLUSIONS
Although considered rare, many cases of cancer of the neovagina are documented in the literature. Careful follow up of patients who have undergone neovagina construction is important.
Schober
Justine M
JM
Department of Pediatric Urology, Hamot Medical Center, Erie, PA, USA. schobermd@aol.com